Iranian Journal of Ophthalmology http://www.irjo.org - www.irjo.org
Iranian Journal of Ophthalmology - Journal articles for year 2008, Volume 20, Number 1Yektaweb Collection - http://www.yektaweb.comen2008/1/11Survey of Iranian Members of American Academy of Ophthalmologyhttp://irjo.org/browse.php?a_id=106&sid=1&slc_lang=en
<p><strong><em>Purpose</em>:</strong> To explore the attitude of the Iranian members towards their American Academy of Ophthalmology (AAO) membership and their utilization pattern of the AAO’s services </p><p><strong><em>Methods</em>:</strong> Mailed questionnaire survey to 34 current AAO members in 2005 </p><p><strong><em>Results</em>:</strong> Twenty nine members (85%) participated. Almost 50% of the members judged the membership process as not being easy. About 80% of the respondents planned to maintain their AAO membership but almost 40% of the participants judged membership dues vs. benefits as high. Free subscription to Ophthalmology journal and free AAO annual meeting registration were the most valuable benefits from the members’ point of view and were reported to be used most as well. Notably, the majority of the participants was interested in E-services (90%) and had browsed the AAO website (85%). </p><p><strong><em>Conclusion</em>:</strong> Cost might be a deciding factor in membership but the ease of membership process and access to the services (actual benefit utilization) seem to be much more important there is a considerable gap between usage and potential benefits for Iranian members i.e. attending AAO annual meeting revision of international membership fee is highly desired.</p><p> </p><p></p><p><span><em><strong>Iranian Journal of Ophthalmology</strong> 200820(1):1-3</em></span></p>S-Farzad MohammadiMalpractice Complaints against Ophthalmologists Referred to the State of Legal Medicine Organization in Iranhttp://irjo.org/browse.php?a_id=107&sid=1&slc_lang=en
<p> <strong><em>Purpose</em></strong><strong>: </strong><strong></strong>Nowadays despite attempts having made by the medical society, health and therapeutic personnel as well as advancements in the therapeutic technology, yet the rate of non-satisfaction and actions by patients continue to increase. The aim of this study was to investigate malpractice complaints against ophthalmologists referred to the state of legal medicine organization. </p><p> <strong><em>Methods</em></strong><strong>: </strong><strong></strong>This is a cross-sectional descriptive study on medical complaints cases against malpractice in the field of ophthalmology referred to the State of Legal Medicine Organization Medical Commission for consideration between 2003 and 2005. SPSS software was used for data analysis. </p><p> <strong><em>Results</em></strong><strong>: </strong>Total medical negligence complaints considered in the medical commission during 3 years was 1581 cases, of them 147 (9.29%) cases were related to the field of ophthalmology. Out of total 147 cases set forth in the commission, in 31 cases it was established that a medical negligence has been occurred. Legally, the most common type of negligence was found to be of type of lack of expertise and in the next rank, carelessness. Among total cases considered in the present study, the majority was allotted to the actions brought against private sector health centers. Out of total approved cases as negligence in consideration, the rate of negligence allotted to the university centers was less than other therapeutic centers. The highest rate of filed complaints was related to the cataract surgery (92 cases), followed by LASIK procedure (21 cases). </p><p><strong><em>Conclusion</em>: </strong>Ophthalmologists are advised, while establishing a good communication and behavior with patients and their companions, to be careful that prior to committing any kind of procedure, to inform patients of probable and unpredictable complications of the treatment and also to have necessary medical consultations plus to apply pre- and post-operative cares. Furthermore, physicians shall be educated about legal issues. </p><p></p><p></p><p><span><em><strong>Iranian Journal of Ophthalmology</strong> 200820(1):4-8</em></span></p>HamidReza DaneshparvarHyperhomocysteinemia and Central Retinal Vein Occlusion in Iranian Populationhttp://irjo.org/browse.php?a_id=108&sid=1&slc_lang=en
<p><strong><em>Purpose</em></strong><strong>: </strong><strong></strong>To evaluate total plasma homocysteine level during the acute phase of central retinal vein occlusion (CRVO) compared with a matched healthy group in Iranian population, and determine whether hyperhomocysteinemia is also a risk factor for CRVO. </p><p><strong><em>Methods</em></strong><strong>: </strong><strong></strong>A study group contains 54 patients presenting with CRVO in recent one month, acute phase of the decease, was compared for fasting total plasma homocysteine level with a matched control group of 51 patients evaluated in the same clinic for a non retinal disease diagnosis. </p><p><strong><em>Results</em></strong><strong>: </strong>The mean total plasma homocysteine level was 14.76±7.67 μmol/l in cases, and 11.42±3.74 μmol/l in control subjects. It shows a significant difference (p=0.005) in mean plasma homocysteine level between the cases and control group. Odds ratio of CRVO for individuals with hyperhomocysteinemia was 2.88 (95% CI=1.08-7.71 and p=0.03). The overall multivariable-adjusted odds of CRVO in participants with plasma homocysteine level above 15 μmol/l was 4.71 (95% CI=1.46-15.19 and p=0.009) Hyperhomocysteinemia was not statistically different in each age group (<60 years: 27%, 61-70 years: 33.3 %, 71-80 years: 31.6%, >81 years: 33.3%, <br>Chi-square test, p=0.98) </p><p><strong><em>Conclusion</em></strong><strong>: </strong>Elevated total plasma homocysteine level is an independent risk factor for CRVO in Iranian population. In addition to an evaluation of all conventional cardiovascular risk factors, measurement of total homocysteine for evidence of hyperhomocysteinemia may be important in the initial investigation and management of patients with CRVO. </p><p> </p><strong><i>Iranian Journal of Ophthalmology </i></strong><i>200820(1):9-15 </i>Sasan MoghimiThe Role of Periocular Carboplatin in Treatment of Advanced Intraocular Retinoblastomahttp://irjo.org/browse.php?a_id=109&sid=1&slc_lang=en
<p><strong><i>Purpose</i></strong><strong>: </strong><strong></strong>To evaluate the results of combined chemotherapy and periocular carboplatin injection to control advanced intraocular retinoblastoma (Rb). </p><p><strong><i>Methods</i></strong><strong>: </strong><strong></strong>In this prospective interventional case-series, we included 8 eyes of 8 patients with advanced intraocular Rb (group C or D in International Intraocular Retinoblastoma Classification, IIRC). In these patients, periocular carboplatin was injected as a primary adjuvant therapy combined with chemotherapy (VEC regimen) or as a secondary treatment in patients who had recurrent disease or did not respond to primary chemotherapy and local modalities. All patients were examined under anesthesia (EUA) and fundus photography was done by Ret–cam before treatment. Fifteen miligrams of carboplatin was injected into subconjunctival or subtenon space in 3-4 weeks interval. </p><p><strong><i>Results</i></strong><strong>: </strong>Eight eyes of eight patients were enrolled. Five patients were male and three patients were female. Mean age of patients at the time of treatment was 34 months and the mean duration between initial presentation of Rb and beginning of treatment was 7.5 months. Mean injection of periocular carboplatin in each eye was 3.1 times. Past medical history in our patients before starting of this treatment included: External Beam Radiotherapy (EBRT) in 3 eyes, cryotherapy in 4 eyes, transpupillary thermotherapy (TTT) in 4 eyes and brachytherapy in 2 eyes. Four eyes were in group C and four eyes were in group D. In 3 patients carboplatin was injected as primary treatment and in five patients it was injected for tumor recurrence following initial treatment failure or relapse. Three patients had vitreous, one had sub-retinal and remaining four had both vitreous and sub-retinal seeding. The degree of seeding was low in two patients, moderate in two patients and severe in four patients. At the end of study, tumor was regressed in six eyes (75%), relapsed in one (12.5%) and recurred in another (12.5%). In both eyes with relapsed and recurrent tumors, enucleation was done. </p><p><strong><i>Conclusion</i></strong><strong>: </strong>Combined chemotherapy and periocular carboplatin injection as well as focal treatment may be an effective method to control advanced intraocular Rb. </p><p> </p><strong><i>Iranian Journal of Ophthalmology </i></strong><i>200820(1):16-19 </i>Masood NaseripourOscillatory Potentials in Diabetic Retina without Retinopathyhttp://irjo.org/browse.php?a_id=110&sid=1&slc_lang=en
<p><strong><i><u>Purpose</u></i></strong><strong>: </strong><strong></strong>To study recordings of oscillatory potentials (OPs) of the electroretinogram (ERG) in diabetic eyes that have no visible fundus alterations, to ascertain whether changes in sensitivity are evident when compared with recordings from age-matched controls. </p><p><strong><i><u>Methods</u></i></strong><strong>: </strong><strong></strong>OPs of the ERG were measured from 68 eyes of 34 patients with diabetes without retinopathy and from 30 eyes of 15 normal subjects. </p><p><strong><i><u>Results</u></i></strong><strong>: </strong>A reduction in the amplitude of each oscillatory potential, as well as delayed implicit time of each oscillatory potential peak could be found in diabetic patients without retinopathy although not all significant. Decrease in the amplitude of OP1 and summed OP (OP-sum) and also delayed the implicit time of OP1 were seen between diabetic patients with no observable diabetic retinopathy. </p><p><strong><i><u>Conclusion</u></i></strong><strong>: </strong>Patients with diabetes without retinopathy show prolonged latencies in OPs recordings and decreased in amplitudes of OP-1 and OP-sum. This indicates an alteration in inner retinal sensitivity or ischemic change of overall retinal layer that can be explained by an impaired rod-cone interaction. </p><p> </p><strong><i>Iranian Journal of Ophthalmology </i></strong><i>200820(1):20-24 </i>Mohammad-Taher RajabiPrimary Open-Angle Glaucoma Risk Factorshttp://irjo.org/browse.php?a_id=111&sid=1&slc_lang=en
<p><strong><i><u>Purpose</u></i></strong><strong>: </strong><strong></strong>The objective of this study was to identify possible risk factors associated with primary open-angle glaucoma (POAG). </p><p><strong><i><u>Methods</u></i></strong><strong>: </strong><strong></strong>A case-control study included patients seen at Rasoul-Akram Hospital ophthalmology clinic. Cases were consecutive patients with confirmed unilateral or bilateral POAG presented during the study period. Controls were a random sample of all other patients aged 30 or more, seen in the same department in the same period who were randomly selected if they fulfilled the inclusion criteria and then matched with the cases by age and sex. Data on demographic, anthropometric as well as medical characteristics were collected from 191 subjects, by interview and medical examination. </p><p><strong><i><u>Results</u></i></strong><strong>: </strong>Sixty consecutive patients with POAG and 131 controls were chosen. Odds ratios (OR) are calculated for the relation between POAG and family history of glaucoma, body mass index, hypertension, diabetes mellitus, cigarette smoking, migraine, and refractive error. Chi-square and student <i>t </i>tests were used. Results indicated the following: family history of glaucoma: OR: 35, 95% CI: 4.57-282.43, P<0.0001, hyperopia: OR: 0.432, 95% CI: 0.209-0.893, P=0.021, hypertension: OR: 1.46, 95% CI: 0.78-2.73, P=0.223, body mass index: P=0.378 (student <i>t</i> test) , migraine: OR: 0.46, 95% CI: 0.098-2.23, P=0.507, and cigarette smoking: OR, 1.81 95% CI, 0.747-4.41 P= 0.184. </p><p><strong><i><u>Conclusion</u></i></strong><strong>: </strong>This study replicated the finding that family history is a major risk factor for POAG (when adjusting for age and sex), while it failed to show that hypertension, diabetes mellitus, myopia, cigarette smoking, migraine, and body mass index to be associated with POAG. It also suggested a protective role for hyperopia in POAG. </p><p> </p><strong><i>Iranian Journal of Ophthalmology </i></strong><i>200820(1):25-31 </i>Mohammad-Taher RajabiAlteration of Tear Film after Vitrectomy and its Influencing Factorshttp://irjo.org/browse.php?a_id=112&sid=1&slc_lang=en
<p><strong><i><u>Purpose</u></i>:</strong> To detect the prevalence of dry eye after vitrectomy and its influencing factors. </p><p><strong><i><u>Methods</u></i></strong><strong>: </strong><strong></strong>Schirmer I, Tear Basic Secretion Test and Tear Breakup Time was done preoperatively and 3 months postoperatively on consecutive patients undergoing vitrectomy in Khatam Hospital from 2005 to 2006. Eyes with previous peritomies of more than 120<sup>◦ </sup>and symptoms of dry eye or tear tests compatible with a diagnosis of dry eye were excluded. Intraoperative factors including the extent of peritomy, extent of inadvertent conjunctival lacerations, extent of scleral depression and the instrument used for scleral depression were recorded. Scleral depression was graded extensive if it was done for more than 180<sup>◦</sup> of globe circumference. </p><p><strong><i><u>Results</u></i></strong><strong>: </strong>Seventy five eyes of 75 patients were studied. Forty six (61.3%) of patients were male. The mean age of the patients was 47.13±18.85 years. Peritomy size was on average 179.33◦±124.75 and the mean size of conjunctival ruptures was 2.18± 4.33 mm . Based on the type of instrument used for scleral depression, patients were divided into 4 groups: 1) metallic instrument, 6 cases (8%) 2) cotton applicator, 32 cases (42.7%) 3) both, 14 cases (18.8%) 4) none (no scleral depression), 23 cases (30.7%). Of 52 cases with scleral depression, the depression was extensive in 35 cases (46.7% of all eyes). Thirteen eyes (17.3%) developed tear film parameters or symptoms consistent with dry eye. All of these eyes had undergone extensive scleral depression. Cotton applicator had been used significantly more in cases which developed dry eye. There was a direct relation between extent of peritomy and inadvertent conjunctival laceration and development of dry eye. </p><p><strong><i><u>Conclusion</u></i></strong><strong>: </strong>Due to damage to the conjunctiva during operation, vitrectomy is apt to cause dry eye. To lower the risk of this complication, scleral depression, peritomy and possibility of inadvertent conjunctival lacerations should be minimized. It is also better to use metallic instruments for scleral depression rather than cotton applicator. </p><p> </p><strong><i>Iranian Journal of Ophthalmology </i></strong><i>200820(1):32-36 </i>Touka BanaeeIris-Supported Artisan Phakic Intraocular Lenses for Treatment of Moderate to High Myopiahttp://irjo.org/browse.php?a_id=113&sid=1&slc_lang=en
<p><strong><i><u>Purpose</u></i></strong><strong>: </strong><strong></strong>To evaluate the efficacy and safety of the Artisan Phakic Intraocular Lens (PIOL) for the correction of high myopia. </p><p><strong><i><u>Methods</u></i></strong><strong>: </strong><strong></strong>In this prospective study of 22 eyes of 14 patients with high myopia, Artisan PIOLs (Ophtec BV) were implanted. Uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), refraction, astigmatism, safety, and predictability were analyzed. </p><p><strong><i><u>Results</u></i></strong><strong>: </strong>The mean of preoperative spherical equivalent was -11.1±3.3 D. An Artisan myopia lens was implanted in 28 eyes of 14 patients with preoperative myopia ranging from -6.0 to -20.0 D. The mean of patient age was 22.7±4.3 years. At three months follow-up, all eyes had a postoperative refraction within±1 D emmetropia. Mean uncorrected visual acuity improved from less than <sup>20</sup>/<sub>200</sub> to <sup>20</sup>/<sub>50</sub>, and mean best corrected visual acuity improved from <sup>20</sup>/<sub>39</sub> to <sup>20</sup>/<sub>30</sub>. The mean endothelial cell loss was 4.45% at three months, which was not significant. Postoperative complications included anterior chamber reaction in 10 (45%) patients that resolved with medical treatment in all of them. No other serious complications developed in any of the treated eyes during follow-up period. </p><p><strong><i><u>Conclusion</u></i></strong><strong>: </strong>Artisan PIOLs can correct moderate to high myopia with good refractive results. There were no serious complications i n this study. </p><p> </p><strong><i>Iranian Journal of Ophthalmology </i></strong><i>200820(1):37-41 </i>Mohammad-Naser HashemianComparison of the Effect of Adjuvant 5-Fluorouracil, Low Molecular Weight Heparin and Daunomycin in Combination with Triamcinolone during Vitrectomy in Advanced Retinal Detachmenthttp://irjo.org/browse.php?a_id=114&sid=1&slc_lang=en
<p><strong><i><u>Purpose</u></i></strong><strong>: </strong><strong></strong>To compare the success rate of adjunctive 5-fluorouracil (5-FU) and low molecular weight heparin (LMWH), and daunomycin in combination with triamcinolone during vitrectomy in eyes with retinal detachment (RD) and proliferative vitreoretinopathy (PVR). </p><p><strong><i><u>Methods</u></i></strong><strong>: </strong><strong></strong>In this prospective randomized clinical trial, 69 eyes from 69 patients with RD and PVR (grade B or C) randomized to 3 groups. Group 1: received 5-FU and LMWH (200 microgram/ml 5-FU and 5 IU/ml LMWH, Fragmin) group 2: received daunomycin (0.5 mg) in <br>500 cc infusion fluid and group 3: control group. In all patients, 0.1 cc intravitreal triamcinolone was used during vitrectomy. The patients visited on day 1, week 1, month 1, 3 and 6. Best corrected visual acuity (BCVA) and retinal status compared in the 3 groups. </p><p><strong><i><u>Results</u></i></strong><strong>: </strong>Complete data were available for 60 out of 69 patients. Thirty five patients (58.3%) were male and 25 patients (41.7%) were female. The patient age range was 19-84 years and the mean age was 49. The groups did not have significant difference in age, sex, duration of detachment, severity of PVR, preoperative visual acuity (V/A), lens status, type of tamponade and encircling band and buckle. Postoperative V/A and retina status also was the same in the 3 groups. </p><p><strong><i><u>Conclusion</u></i></strong><strong>: </strong>Perioperative infusion of 5-FU, LMWH and daunomycin does not significantly increase the success rate of patients with RD and PVR comparing to control group. Although visual acuity improvement and retina reattachment rate in group 1 and 2 were better than control group, but statistical analysis failed to show significant difference between the 3 groups. </p><p> </p><strong><i>Iranian Journal of Ophthalmology </i></strong><i>200820(1):42-47 </i>Ahmad MirshahiConcomitant Carotid-Cavernous Fistula, Chorioretinitis Sclopetaria, and Optic Nerve Transectionhttp://irjo.org/browse.php?a_id=115&sid=1&slc_lang=en
<p>A 15- year-old boy with history of BB gun injury to his left eye was referred to our center. His visual acuity was no light perception in the left eye. Ocular findings were severe proptosis, conjunctival injection, and conjunctival vascular tortuosity. Fundus examination revealed an extensive inferior chorioretinal scar compatible with chorioretinitis sclopetaria. A distinct bruit was detected by left orbital auscultation. Orbital and brain CT- scan showed transected optic nerve by the BB gun pellet which lodged at the left parasellar area. Cerebral angiography showed a high flow direct carotid-cavernous fistula that was successfully treated by endovascular embolization. This patient is the first reported case of concomitant carotid-cavernous fistula, optic nerve transection, and chorioretintis sclopetaria due to BB gun injury. </p><p> </p><p><strong><i>Iranian Journal of Ophthalmology </i></strong><i>200820(1):48-50 </i></p>Mohammad-Taher RajabiیDelayed Onset Bacterial Keratitis after Implantation of Intrastromal Corneal Ring Segmentshttp://irjo.org/browse.php?a_id=116&sid=1&slc_lang=en
<p>The incidence of microbial keratitis after Intacs implantation is extremely low and channel infection has been infrequently reported. We present a 23-year-old woman with keratoconus of both eyes who underwent implantation of two intrastromal corneal ring segments (Intacs, KeraVision, Inc., Fremont, CA, USA) in the right eye. After 2.5 months, the patient presented with decreased vision, inflammation, and stromal infiltration at the lower channel site of Intacs. Culture was positive for <i>Escherichia coli</i>. The patient was treated with removing of lower segment of Intacs, and subconjunctival and topical antibiotics. The keratitis resolved, leaving opacity and thinning and mild neovascularization in the lower channel site. Our case report illustrates the risk of microbial keratitis even months after Intacs implantation. It shows need for long-term postoperative attention by both patient and physician. </p><p> </p><strong><i>Iranian Journal of Ophthalmology </i></strong><i>200820(1):51-54 </i>Mohammad-Taher Rajabi